Persistent sleep problems among people in recovery from substance use disorders: a mixed methods study

Background The aims of this study are to examine the one-year trajectory of sleep problems, identify clinical correlates, and describe subjective experiences related to persistent sleep problems during recovery from substance use disorders (SUD). Methods This study builds on a sequential mixed method design. The quantitative component features data from a prospective longitudinal study of 127 poly-SUD patients in the Stavanger area in Norway, while the qualitative component describes a thematic analysis of interviews with 16 persons from this study still experiencing sleep problems after at least one year of abstinence. Results The prevalence of sleep problems at baseline for the whole cohort was 79%. Among the 59 patients who were abstinent after one year, N = 20 (33.9%) had moderate and N = 11 (18.6%) had severe sleep problems. Persistent sleep problems were associated with psychological distress and were experienced as a major challenge in the struggle to stay drug free. Establishing daily routines related to work, school, and care for children were coping strategies for participants with persistent sleep problems. Conclusions Persistent sleep problems are often overlooked in a clinical setting. Based on our findings, these issues pose a major challenge in the struggle to stay drug free. For patients with psychological distress, and lack of responsibilities that established daily routines, sleep difficulties may result in increased risk of drug use episodes that result in relapse. These results argue that screening and evidence-based methods for insomnia and sleep health-programs should be commonplace adjunct intervention for patients with SUDs.publishedVersio

To be or not to be diagnosed : A qualitative study about special teacher’s/special educationalist’s view of the phenomenon ADHD and DAMP

Aim & Questions at issue The aim of our study is to study how special teachers/special educationalists in schools of Stockholm look at the phenomenon ADHD/DAMP. We have looked into their view on the diagnose, compared to the two different kinds of research visions about the diagnosis who are known in Sweden today. How do the special teacher/special educationalist work with the diagnosed children? This is our questions at issue: • Is there any optimal learning situation for children with ADHD/DAMP? • Is there something that distinguish all children with ADHD/DAMP? • What is positive and negative about giving the diagnose ADHD/DAMP to children? • Is there any external factors that influence that there is so many more children today who has been given a diagnose? • How does special teachers/special educationalists look on amfetamin-treatment? Method We have done qualitative interviews with special teachers/special educationalists in the city area of Stockholm. These have been worked up one by one and then been compared and evaluated together. Result All special teachers/special educationalists mentioned that when you educate children with ADHD/DAMP, a structured life underlies the possibility for the children to provide knowledge. It’s also of importance to vary the way of working to make the children concentrate and keep their interest. If there is any general optimal learning solution for children with ADHD/DAMP is hard to say at the time when the answer we have been given are prominent distinguish. The same ambiguity was the question of characteristic among these children but most of the special teachers/special educationalists considered “ants in their pants” as a common factor. All special teachers/special educationalists were uninterested of the diagnoses it self. They considered all children with special needs should be given some kind of help. Most of them didn’t mention any positive things about a diagnose from the children’s point of view but from the schools perspective a diagnose can lead to bigger resources compared to a children without a diagnose. The stress in society affects the number of diagnosed children. The special teachers/special educationalists had a positive thought about treatment with amphetamine if it is combined with other methods. Conclusion The different kinds of answers we have got in our study shows that there is no common direction between the special teacher/special educationalist pertain the subject ADHD/DAMP.Syfte & Frågeställningar Syftet med vår studie har varit att studera hur speciallärare/specialpedagoger i Stockholmsskolor ser på fenomenet ADHD/DAMP. Vi har jämfört deras syn på diagnostisering med de forskarläger som finns i Sverige idag. Nedan följer de frågeställningar vi har valt att inrikta oss mot. • Hur arbetar speciallärare/specialpedagoger med elever som fått diagnosen ADHD/DAMP? • Finns det någon optimal inlärningssituation för barn med diagnosen ADHD/DAMP? • Finns det något som kännetecknar barn med diagnosen ADHD/DAMP? • Vad är positivt respektive negativt med att barn får diagnosen ADHD/DAMP? • Finns det yttre faktorer som kan påverka att det i dagens samhälle är så många barn som får diagnosen ADHD/DAMP? • Hur ser speciallärare/specialpedagoger på amfetaminbehandling? Metod Vi har valt att göra kvalitativa intervjuer med speciallärare/specialpedagoger i Storstockholmsområdet. Intervjuerna har bearbetats var och en för sig och därefter jämförts i syfte att urskilja sam- och/eller särsyn på fenomenet ADHD/DAMP. Resultat Alla de intervjuade speciallärarna/specialpedagogerna nämnde att när man undervisar barn med ADHD/DAMP så är en strukturerad tillvaro grunden för att barnen ska kunna tillgodose sig kunskap. Viktigt är även ett variationsrikt arbetssätt för att barnen ska kunna koncentrera sig och behålla intresset. Om det finns någon generell optimal inlärningssituation för barn med ADHD/DAMP är svårt att säga eftersom de svar vi fått skiljer sig markant åt. Samma tvetydighet var det kring frågan om kännetecknande egenskaper hos dessa barn. De flesta speciallärare/specialpedagoger ansåg ändå att en igenkännande faktor var att de hade ”myror i rumpan”. Samtliga speciallärare/specialpedagoger var ointresserade av själva diagnosen. De menade att alla barn med behov av stöd i någon form ska få hjälp. Överlag nämndes inte några positiva sidor med att ha eller att ställa en diagnos ur barnets synvinkel, men ur skolans perspektiv kan en diagnos leda till att större resurser tilldelas. Många menar att den stress som finns i samhället idag påverkar antalet diagnostiserade barn. Speciallärarna/specialpedagogerna var överens om att amfetaminbehandling till barn med svåra koncentrationssvårigheter är positiv om den kombineras med andra metoder. Slutsats De olikartade svaren som vi fått i vår studie visar att det inte finns någon gemensam riktning bland de intervjuade speciallärarna/specialpedagogerna gällande bemötandet av barn med ADHD/DAMP

Persistent sleep problems among people in recovery from substance use disorders: a mixed methods study

Background The aims of this study are to examine the one-year trajectory of sleep problems, identify clinical correlates, and describe subjective experiences related to persistent sleep problems during recovery from substance use disorders (SUD). Methods This study builds on a sequential mixed method design. The quantitative component features data from a prospective longitudinal study of 127 poly-SUD patients in the Stavanger area in Norway, while the qualitative component describes a thematic analysis of interviews with 16 persons from this study still experiencing sleep problems after at least one year of abstinence. Results The prevalence of sleep problems at baseline for the whole cohort was 79%. Among the 59 patients who were abstinent after one year, N = 20 (33.9%) had moderate and N = 11 (18.6%) had severe sleep problems. Persistent sleep problems were associated with psychological distress and were experienced as a major challenge in the struggle to stay drug free. Establishing daily routines related to work, school, and care for children were coping strategies for participants with persistent sleep problems. Conclusions Persistent sleep problems are often overlooked in a clinical setting. Based on our findings, these issues pose a major challenge in the struggle to stay drug free. For patients with psychological distress, and lack of responsibilities that established daily routines, sleep difficulties may result in increased risk of drug use episodes that result in relapse. These results argue that screening and evidence-based methods for insomnia and sleep health-programs should be commonplace adjunct intervention for patients with SUDs

Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial

International audienceAbstract Background Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO 2 ) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO 2 with patients’ outcome. Methods Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO 2  300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. Results 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93–1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95–1.06). The time exposure, i.e., the area under the curve (PaO 2 -AUC), for hyperoxemia was significantly associated with mortality ( p = 0.003). Conclusions In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. Trial registration : clinicaltrials.gov NCT02908308 , Registered September 20, 2016

Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial

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